Diseases of Gall Bladder and Bile Ducts

The following points highlight the three major diseases of gall bladder and bile ducts. The diseases are: 1. Gall-stones (Cholelithiasis) 2. Acute Cholecystitis 3. Chronic Cholecystitis.

Disease # 1. Gall-stones (Cholelithiasis):

The bile is concentrated in the gall-bladder and when it is supersaturated gall-stones are likely to form. Super saturation arises when there is an insuf­ficiency of solubilizing agents such as bile acids and lecithin to keep cholesterol and bile pigments in solution. The most common gall-stones are com­posed of cholesterol, bile pigment and various cal­cium salts including calcium palmitate.

In the cen­tre is a protein nidus. This suggests an infective origin. The stones are usually multiple and their surfaces faceted. Pigment gall-stones are more preva­lent in the eastern world and may be due to in­creased hemolysis arising from the sickle cell trait and thalassemia.

Gall-stones are more common in women than in men. Advancing age, repeated pregnancies and sedentary life and the use of oral contraceptives are contributing factors.

The formation of cholesterol gall-stones de­pends on the concentration in the bile of choles­terol relative to that of the conjugated bile acids and lecithin. High cholesterol concentration may arise from either excess of cholesterol or lack of bile acids.

Excess cholesterol may be due to in­creased activity of HMG-CoA reductase. Deficiency of bile acid may be due to deficiency of the en­zyme that controls their formation (cholesterol-7a- hydroxylase).

The symptoms due to gall-stones are removed surgically often a stone causes no symptoms and then there is no strong case for its removal. Some gall-stones can be dissolved in the gall­bladder by administration of the bile acid, chenodeoxycholic acid.

In a large trial complete dissolu­tion occurred in 13.5 per cent of cases after two years with some adverse effects—diarrhoea and a slight rise of plasma cholesterol. So it is only for treatment of elderly, frail or who are losing weight before operation.

Disease # 2. Acute Cholecystitis:

It is rarely due to infection of the gall-bladder but almost always occurs in association with obstruc­tion to the cystic duct or neck of the gall-bladder, upon which infection is usually superimposed. In most cases gall-stones are the cause of obstruction.

1. Treatment:

(a) Cholelithiasis with accompanying chole­cystitis is the choice of the surgeon to post­pone operation until the acute infection has subsided.

(b) The patient should be in bed and given suitable analgesics and antibiotics.

(c) Heat should be applied to the gall-blad­der region and ample fluid is given intra­venously if the patient is vomiting.

(d) So long as the gall-bladder is acutely in­flamed, it is advisable to keep the organ at rest as far as possible.

(e) For acute cases an entirely fluid diet of at least 2 to 3 litres daily, given in small feeds at hourly or two-hourly intervals, is ad­visable for a few days.

(f) When the condition is improved within two or three days, clear soups, milk, fruit jellies, and cereals may be added, and the diet is rapidly built up to normal.

(g) After recovery if there are gall-stones or non-functioning gall-bladder, cholecys­tectomy should be advised.

Disease # 3. Chronic Cholecystitis:

If it is decided not to remove the gall-bladder or if for any reason operation is suspended, dietetic treat­ment should be given.

(a) Foods which aggravate the symptoms should be avoided.

(b) The cooked meats rich in fat and fried foods be given.

(c) Milk, butter and cream cheese is permit­ted, and may promote drainage of the gall­bladder.

(d) Eggs may be permitted in moderation, if they do not cause symptoms.

(e) The diet should be bland and contain ad­equate protein.

(f) Care should be taken to avoid large meals and indigestible articles of food, and am­ple quantities of fluids should be taken in the morning and between meals.